Health Reform’s House Breakout The GOP needs to show the country—and Trump—it can govern.
https://www.wsj.com/articles/health-reforms-house-breakout-1493852954
Against the odds, House Republicans have regained momentum on health-care reform, and they’re nearing a majority coalition. While there may be more swerves before a vote, they ought to appreciate the importance of demonstrating that a center-right Congress—working with President Trump —can govern.
There are still holdouts and others are undecided in the GOP’s moderate and conservative wings, but their differences are narrowing. More members are also recognizing their political mistake in trashing the original ObamaCare repeal and replace bill. The House now has a rare second chance, and a generational opportunity to start to solve some U.S. problems.
On Wednesday Fred Upton of Michigan and Billy Long of Missouri worked out the latest compromise, meant to assuage concerns about insurance for pre-existing medical conditions. The amendment would add $8 billion over five years to a 10-year, $130 billion fund to create risk pools to protect people in the individual insurance market who need high-cost treatments.
Pre-existing conditions are an understandable concern, but the critics traffick in demagoguery, not substance. Their opposition has less to do with vulnerable patients than preserving ObamaCare. Senate Minority Leader Chuck Schumer claimed that risk pools are “like administering cough medicine to someone with stage 4 cancer,” which exploits cancer victims and shows he knows nothing about risk pools.
By targeting funds at the sickest patients, states can make insurance markets more affordable and stable. These subsidies siphon off some of the costs that contribute to rising premiums in the overall market, and the idea is that the resulting cheaper plans for everyone else will encourage more people to enroll.
In Alaska, ObamaCare premiums rose 40% annually over multiple years, one of the two participating insurers exited the business, and the other was on the brink. So the state received a federal waiver last year to create a risk pool. Premiums rose 7.3% on average for 2017.
Opponents say risk pools are underfunded, but the Alaska rescue mission cost merely $55 million (albeit in a low-population state). The results came despite ObamaCare’s restraints, and the GOP’s American Health Care Act promises more regulatory flexibility to experiment. Opponents also argue that risk pools are ghettos for the sick, but the Alaska payments are “invisible,” meaning that all consumers use regular insurance.
We’ll learn soon if risk pools are enough to win over GOP moderates, but they should know that Democrats will demagogue the pre-existing conditions issue in the 2018 election whether the bill passes or not. Better to pass the bill, and explain to their voters why their reform is better for patients, than defend a failure. HillaryCare’s crash didn’t save vulnerable Democrats in 1994—though unlike Democrats, this time Republicans have a good product to sell.
The pre-existing conditions furor also shows that conservatives were wrong to oppose the original House bill. They achieved little beyond opening up a politically toxic debate. Risk pools require government spending but they’re a proven tool that can mitigate some of ObamaCare’s damage, and time and money are needed to repair insurance markets. Rejecting a replacement over this or that provision means preserving the ObamaCare status quo.
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This political reality applies to all corners of the GOP. Republicans—conservatives and moderates—have campaigned for more than seven years on repealing and replacing ObamaCare, and voters in 2016 gave them control of government. If Republicans can’t follow through now, the public will conclude that they’re either dishonest or feckless, and then wonder if they deserve their jobs.
Another failure would add to the dysfunction narrative of the Trump Administration, and there’s no telling how the President would react. For now the White House is invested in a fairly conventional center-right economic agenda. One reason the health bill was raised from the dead has been the President’s backstage leadership and his personal, member-by-member appeals.
But Mr. Trump wants above all to be a “winner” and he’s likely to align himself with whatever majority he can find. If Speaker Paul Ryan and Mitch McConnell in the Senate can’t deliver, this least ideological of Presidents may turn in 2018 or sooner to Nancy Pelosi and Mr. Schumer to make deals—on roads, bridges and airports, or trade tariffs, or who knows what else. You can bet the results won’t please conservatives.
More important than the configurations of Beltway power is showing that center-right reforms can improve American lives. Republicans haven’t been in charge for a decade and the failures of the progressive project—flat incomes, above all—explain much of the country’s current political distemper.
Mr. Trump and the GOP need to follow through on their pledges of economic growth and government reform, and convince Americans that a better future awaits. Health-care progress will lift the rest of their program. It is only a minor exaggeration to think that health-care reform is a do-or-die moment for the GOP Congress.
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